Drug users in the South: access to HCV treatment
ANRS/NIDA DRIVE-IN, a study supported by the ANRS and the US National Institute on Drug Abuse (NIDA), has shown in Haiphong, Vietnam, that a large-scale program for risk reduction and increased access to antiretroviral therapies greatly reduced HIV incidence in people who inject drugs. The HCV epidemic, on the other hand, continues unabated in this population, despite high coverage of harm reduction interventions. Only broad access to highly effective treatments will enable eradication of hepatitis C among people who inject drugs in Vietnam. The ANRS/NIDA DRIVE-IN results will be presented by Professor Pham Minh Khuê (Faculty of Public Health, Haiphong University of Medicine and Pharmacy) in an oral communication on July 25, during the 9th IAS Conference on HIV Science, organized by the International Aids Society and the ANRS in Paris from 23 to 26 July 2017.
Image issue d'un film réalisé par Mr Hà Quang Hiêp membre du groupe d'UDI Friendship Arm.
In Vietnam, people who inject drugs (PWID) constitute the population most affected by HIV/AIDS and hepatitis C. ANRS and NIDA support various research programs in Vietnam, thus assisting the national authorities in their fight against these epidemics. One such program, ANRS/NIDA DRIVE-IN, has assessed the feasibility of an interventional program among PWID in the city of Haiphong. On July 25 at the 9th IAS Conference on HIV Science, organized by the International Aids Society and the ANRS in Paris, Professor Pham Minh Khuê will give an oral presentation on the results of this study of the dynamics of the HCV and HIV epidemics among PWID.
603 PWID recruited through respondent driven sampling method conducted with a self-support groups were offered screening tests, which showed that 25 % of them were seropositive for HIV and that 66 % were seropositive for HCV. These results reveal high prevalence of HIV and HCV infections among PWID, who are therefore a key population regarding these epidemics.
Among these 603 PWID, 204 were included in a cohort and were followed up for one year, with screening every six months for those who had been tested negative for HIV and/or HCV. During follow-up, the participants had access to a community-based risk reduction program (communication on harm reduction, safe injection and safe sex, distribution of syringes/needles and condoms) and received assistance in accessing to methadone services and antiretroviral treatment for HIV-infected participants. Among these 204 PWID, at baseline: 94 (46 %) were seronegative for both HIV and HCV, 105 (51 %) were seropositive for HCV alone, and 5 (2 %) seropositive for HIV alone. After one-year follow-up, no new HIV infections were observed. In contrast, there was a high incidence of HCV, with 18 new infections. Multivariate analysis indicated a strong correlation between the reported number of injections monthly and the risk of infection: those PWID who self-injected more than 75 times a month were infected most likely by HCV.
Dr Didier Laureillard, the coordinator of the ANRS site in Vietnam, considers that “These results show that the efforts made over the last ten years or so in Vietnam to reduce risk and to increase access to antiretrovirals among PWID have paid off. HIV incidence has decreased markedly in this population. This is a very encouraging result, showing that it is possible to act effectively among PWID.”
In contrast, the situation regarding hepatitis C is very worrying. Professor Pham Minh Khuê (Faculty of Public Health, Haiphong University), who is a co-investigator of ANRS/NIDA DRIVE-IN, speaks of the results: “In terms of HCV, it is today essential to implement an approach similar to that which we have been using to control HIV. Harm reduction programs designed for HIV appear insufficient to combat the HCV epidemic and need to be adapted. But the essential measure that could reduce the incidence of hepatitis C is broad access to new highly effective treatments as performed successfully for HIV infection. At present, very few patients with hepatitis C receive these treatments.”
“This objective is all the more crucial,” adds Dr. Laureillard, “because with these treatments it is possible to cure hepatitis C in nearly all patients in a few months. We could therefore rapidly eradicate the epidemic, not only among PWID, but also in the general population.”
Following the feasibility study ANRS/NIDA DRIVE-IN, the ANRS- and NIDA-supported DRIVE study was launched in September 2016. This study will, after 4 years of follow-up, evaluate the benefits of the community-based intervention drawn up during ANRS/NIDA DRIVE-IN, but this time scaled up to a population level, in the whole city of Haiphong in Vietnam. The new study will recruit 1500 PWID every year.
Professor François Dabis, Director of the ANRS, says that “Access to treatments of HCV infection is a challenge not only for Vietnam, but for all resource-limited countries affected by this epidemic. In terms of research, we must undertake new studies for large-scale assessment of HCV treatment as a new tool for prevention of this infection.”
Low HIV incidence but high HCV incidence among people who inject drugs in Haiphong, Vietnam: Results of the ANRS 12299/NIDA P30DA011041 DRIVE-IN study
M.K. Pham1, J.P. Moles2, H. Duong Thi1, T. Nguyen Thi3, G. Hoang Thi4, T.T. Nham Thi5, V. Vu Hai6, H.O. Khuat Thi5, R. Vallo2, M.Peries2, K. Arasteh7, C. Quillet2, J. Feelemyer7, L. Michel8, T. Hammett9, N. Nagot2, D. Des Jarlais7, D. Laureillard2,10, DRIVE study group
1 Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam, 2University of Montpellier, Inserm U1058, Etablissement Français du Sang, Montpellier, France, 3Haiphong Provincial AIDS Center, Haiphong, Vietnam, 4Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam, 5Supporting Community Development Initiatives, Hanoi, Vietnam, 6Dept of Infectious and tropical diseases, Viet Tiep Hospital, Haiphong, Vietnam, 7Icahn School of Medicine at Mount Sinai, New York, United States, 8CESP/Inserm U1018, Pierre Nicole Centre, French Red Cross, Paris, France, 9Abt Associates, Cambridge, MA, United States, 10Infectious Diseases Department, Caremeau University Hospital, Nimes, France.